"The future of surgery is not about blood and guts; the future of surgery is about bits and bytes.”
/Dr. Richard Satava/

Monday, May 28, 2012

Visiting SRI

Stanford Research International (SRI) has had a great role in the development of surgical robotics. First, they developed the Green Telepresence system that was the very first robot to allow remote patient care. The technology was licensed by Intuitive Surgical, and it genarates a great source of revenue through the royalty fees. Later, they developed the light-weight verson of the robot, the M7, around 1998. The system weights only 15 kg, and it is equipped with two 7 DOF arms, motion scaling (max. 1:10), tremor filtering and haptic feedback. The end-effectors can be changed very rapidly, and even a laser tissue welding tool can be mounted on it. The controller has been designed to operate under extremely different atmospheric conditions, therefore it only contains solid-state memory drives. The software of the M7 was updated later to better suit the requirements of teleoperation and communication via Ethernet link. The M7 performed the world’s first automated ultrasound guided tumor biopsy in 2007, and was also used for suturing lacerations of the cornea. SRI developed a very neat master controller and various tools for it. I was given a unique opportunity to visit their facility, guided by Dr. Tom Low, the director of the medical robotics group.

Most of SRI's development was achieved within the frames of the Trauma Pod (TP); Operating room of the future project, which was a "DARPA program to develop a semi-autonomous telerobotic surgical system that could be rapidly deployed and provide critical diagnostic and life-saving interventions in the field.  The footprint was 8ft x 18ft so that it could to fit within an ISO shipment container for ready deployment. The Phase I proof of concept platform was comprised of a da Vinci Classic surgical robot supported by an automated suite of commercially available and custom designed robots. The surgeon remotely controlled the robotic suite to perform representative tasks that included placing a shunt in a simulated blood vessel and performing a bowel anastamosis. The Scrub Nurse Subsystem (SNS) system, developed by Oak Ridge National Laboratory, automatically delivered instruments and supplies to the surgical robot within 10 sec (typically faster than a human). The Tool Rack System (TRS), developed by the University of Washington, held, accepted, and dispensed each of fourteen surgical tools.  The Supply Dispensing System (SDS), developed by General Dynamic Robotic Systems, provided sterile storage, delivery and tracking of standard surgical supplies. The Supervisory Controller System SCS, developed by University of Texas, provided high-level control of all automated subsystems involved in supply dispensing / tool changing and coordinated these functions with the surgical robot.  The Patient Imaging (GE Research) utilized the L-STAT platform to embed CT like capabilities as well as 2-D fluoroscopic data. The User Interface System (UIS) developed by SRI International provided a visual, verbal, aural, and gesture-based interface between the surgeon and TP system.  The visual display consisted of a stereoscopic view of the surgical site augmented by physiologic data, icons and other supporting information.  Results from the Phase I demonstration in 2007 included:
  • Automatic storing and dispensing of surgical tools by the TRS with 100% accuracy
  • Automatic storing, de-packaging dispensing and counting supplies by the SDS
  • Automatic change of surgical tools and delivery and removal of supplies by SNS
  • Speech-based interface between a tele-operating surgeon and the system through the UIS
  • Automatic coordination and interaction between system components such as the SRS and SNS
  • Performing iliac shunt and bowel anastamosis procedures on a phantom by a tele-operated SRS.
Moreover, RST and SRI International joined forces in May 2006 for a first-ever demonstration of unmanned telesurgery involving a robotic surgeon and a robotic scrub technician.  Penelope 3.0 delivered supplies to SRI’s M7 which used them to carry out sponging and suturing of a simulated surgical wound."

"U.S. Army TATRC also funded University of Cincinnati and SRI to explore distributed, automated surgical robotics as a means to augment en route care of injured warfighters. In 2007, the M7 was modified to overcome acceleration and movement routinely encountered during vehicle transport. Three-axis acceleration compensation was developed to dampen turbulence and apply a neutralizing force during periods ofmore constant acceleration.Multiple military personnel, including a U.S. Air Force Critical Care Air Transport (CCAT) surgeon, demonstrated robust performance of the acceleration compensating M7 during parabolic flight aboard NASA’s DC-9 aircraft."

Thursday, May 24, 2012


Vintage photos from the first Intuitive prototype: Lenny, 1996.

Tuesday, May 22, 2012

Revisiting the da Vinci

While I was back to Intuitive in February to meet some of their great people, I started to collect some interesting systems developed by external groups to work with the da Vinci. (Beyond the in-house development, such as the single-site tools.)

Primarily, the MIMIC dV trainer has already become an integrated producut of Intuitive. You can learn more about the origins ofthe simulator here. There have been other HW+SW simulators developed as well; the most advanced is probably the RoSS,but these is also an interesting one from China, where they fully identified the kinematic parameters of the robot.

Many groups got interested in working with the da Vinci (e.g. for skill assessment and event analysis), but only few got the chance to easily hook up with the system using the research API. As Intuitive puts it, it is closed for conficentiality, safety reasons, to support resources and the provide competitive advantage to key partners. To our knowledge), only the Hopkins group has a read-write API. Thus people at UPenn developed the VerroTouch system, that uses accelerometers to identify all motions of the arms. (More details here.)

Further, BlakeHannaford’s group (Biorobotics Lab) at UW came out with the concept of SurgTrak, an affordable da Vinici data recording tool. The system consists of synchronized video and surgical tool motion recording unified by custom software. Video is recorded at up to 30 frames per second from the DVI output of the da Vinci master console using an Epiphan DVI2USB device. Tool motion data is recorded at 30 Hz. Tool position and orientation are captured with a 3D Guidance trakSTAR magnetic tracking system. Grasper and wrist position is recorded by measuring the angular position of the four spindles driving the four tool degrees of freedom. Custom USB-enabled hardware was developed for this task including a set of inexpensive potentiometers that extract absolute spindle angle as well as additional environmental signals such as tool contact. Data streams from the video recording, position recording and wrist signal recording are united using Visual C++ software running on a Windows 7 based laptop computer utilizing the windows multimedia timer to enforce a consistent sampling rate.

Of course, new instruments require new design of the OR, for which you can find someguidelines here.

Image credit: - Intuitive: History, Present, Future of Robotic Surgery, 2011

Sunday, May 20, 2012

Summer CIS Coctail

Looking for a nice travel for the summer?
You can get it all! It begins with the nicely arranged Italian Bioengineering week:
See you all there!

Friday, May 18, 2012

Intuitive's Technology Research Grant call

Clinical-technological research grants are available. All submissions due June 1, 2012. Further details are on Intuitive's site. 
"The purpose of these grants is to support technology research in the field of surgical robotics, or related fields. Successful proposals will address clinically-relevant technology development. Grants will be awarded to researchers at non-profit academic institutions worldwide. Awards will be conferred on a competitive basis by submission of a grant application.  
Applicants may apply for $10,000 to $50,000 of funding per project (US Dollars, total costs). The grant monies can be used to fund salaries, equipment, supplies and/or travel required to support the proposed research project for a period of up to one year.
All invited full grant applications will be reviewed and scored based on the following criteria:
  • Clarity of research goals and objectives.
  • Novelty and innovation.
  • Clinical relevance and value.
  • Evidence of feasibility.
  • Strength of evaluation methods and measures.
  • Availability of required resources.
A two-page letter of intent to propose should be submitted by all grant applicants in 12pt type face. Submissions should consist of 5 parts:
  • Summary: one or two sentence proposal overview.
  • Description of Problem/Background.
  • Purpose, Hypothesis and Methods of research (not more than 500 words) for the project.
  • Capabilities: Indicate the identities, capabilities and credentials of investigators as well as any participating institution. Include contact information for applicant principle investigator.
  • Budget: Include a rough project budget that includes estimated costs for staff, equipment, consumables, and other direct costs. Applicants can request up to $50,000 in total costs, with no more than 20% of this total constituting indirect costs."
Run your on experiment on a da Vinci! 
Source: Intuitive Inc.

Tuesday, May 15, 2012

CIS news

Quote of the week: "Da vinci is a 21st century device, doing 19th century type surgery, based on the 20th century MIS paradigm." 
/Russell H. Taylor/
 Image credit: IMRIS

Friday, May 11, 2012

Visiting Hansen Medical

Hansen Medical was founded as a spin-off of Intuitive Surgical in 2002. Fred Moll, who ran Intuitie at the beginning moved over to Hansen, but by now, he is into hair restoration. In February, I was given a private tour by VP Jean Chang, able to see first hand all their development and production in Mountain View.

First, they released the Sensei X Robotic Catheter System in 2005 for electrophysiology, and now they also have the Magellan Robotic System and the NorthStar Catheter 
"Hansen developed the Sensei master-slave robotic system to control catheters with a focus on use in cardiac electrophysiology procedures, such as ablation. Currently, these procedures require precise control of the catheter tip to deliver appropriate ablation to the cardiac conduction pathways while exposing cardiac electrophysiologists to high levels of fluoroscopic radiation needed for visualization. The Sensei system was designed to address both of these issues by providing physicians better control and decrease their radiation exposure.
The slave is a robotic arm positioned at the foot of the procedure table and controlled via pull wires through an external and internal sheath that can carry traditional ablation catheters. The external sheath has 1 pull wire that allows it to be deflected, rotated, and inserted/withdrawn. The internal sheath has more control with a pull wire in each quadrant providing it the capability to move 360° and also be inserted or withdrawn. Ablation catheters are positioned just past the internal sheath and the physician can control its motion via the master’s 3D joystick. The physician can view the procedure with traditional fluoroscopic image and can also integrate real-time electroanatomic mapping (EAM) and 3D
CT imaging with the robotic catheter positioning. A preoperative 3D CT image of the heart can be registered with EAM information. Similar to the da Vinci Surgical System, the controls can also be scaled with 1:1 or 4:1 ratios. Since the masters do not provide haptic feedback through the controls, the IntelliSense system detects forces at the catheter tip and uses synesthesia with a visual warning when the tip forces are concerning for risk of perforation."
Sales are slowly taking off, since the EU cleared the Magellan robotic system last summer. They also have conditional FDA IDE approval. The Magellan system was first used clinically last year.

 Hansen got its competition early. The CorPath 200 System (Corindus Vascular Robotics of Natick, Mass.) goes head to head (now under the umbrella of Phillips Medical). (Showing some good results.) And also, Medrobotics, Cathether robotics with Amigo, or the Vdrive system from Stereotaxis.
On the top of that, Stereotaxis develops magnetic-driven catheters, the Niobe system. 

Monday, May 7, 2012

19. MMVR conference

MMVR 19 was a great event, mostly thanks to Jim D. Westwood, the soul of the event. 
Prof. Satava was there, as always (he regularly does great overview talks at MMVR, similar to this one).
You can learn a lot from the full proceedings. Some more exciting topics:
You can access the full proceedings here.
The exibition along MMVR was even more exciting. 
NDI and Polhemus tracking companies, DARPA financed haptics and adaptive patient phantoms. Also a lower torso. Was deeply impressed by the work of SenseGraphics. You can explore their Hall of Fame here
Stay tooned for the 20th MMVR in 2013!

Friday, May 4, 2012

The Teledactyl from 1925

Previously we have touched the amazing 1925 projections of a haptic telesurgery system (1925 February issue of Science and Invention magazine). Here are some more fascinating details from Hugo Gernsback:
"The Teledactyl (Tele, far; Dactyl, finger — from the Greek) is a future instrument by which it will be possible for us to “feel at a distance.” This idea is not at all impossible, for the instrument can be built today with means available right now. It is simply the well known telautograph, translated into radio terms, with additional refinements. The doctor of the future, by means of this instrument, will be able to feel his patient, as it were, at a distance….The doctor manipulates his controls, which are then manipulated at the patient’s room in exactly the same manner. The doctor sees what is going on in the patient’s room by means of a television screen.
Here we see the doctor of the future at work, feeling the distant patient’s arm. Every move that the doctor makes with the controls is duplicated by radio at a distance. Whenever the patient’s teledactyl meets with resistance, the doctor’s distant controls meet with the same resistance. The distant controls are sensitive to sound and heat, all important to future diagnosis.
The busy doctor, fifty years hence, will not be able to visit his patients as he does now. It takes too much time, and he can only, at best, see a limited number today. Whereas the services of a really big doctor are so important that he should never have to leave his office; on the other hand, his patients cannot always come to him. This is where the teledactyl and diagnosis by radio comes in."